One Flew Over the Cuckoo's Nest

What does the small brass tablet that reads "congratulations for getting along with thesmallest number of personnel of any ward in the hospital" indicate?

One flew over the cuckoos nest

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Ratched is responsible for many "acute" patients becoming "chronic" patients. THe sign attests to Ratched's power over acute patients, they behave lest they be labeled chronic. That's why she needs so little staff.